Healthcare Provider Details

I. General information

NPI: 1609009380
Provider Name (Legal Business Name): PINNACLE DERMATOLOGY, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2009
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3655 PLYMOUTH BLVD SUITE 110
PLYMOUTH MN
55446-3664
US

IV. Provider business mailing address

5141 VIRGINIA WAY STE 350
BRENTWOOD TN
37027
US

V. Phone/Fax

Practice location:
  • Phone: 612-486-4200
  • Fax: 612-486-4201
Mailing address:
  • Phone: 629-666-2462
  • Fax: 629-666-2462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: PAULA LAPINSKI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 815-744-8554